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Subarachnoid hemorrhage randomized

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https://www.readbyqxmd.com/read/28298031/analysis-of-saccular-aneurysms-in-the-barrow-ruptured-aneurysm-trial
#1
Robert F Spetzler, Joseph M Zabramski, Cameron G McDougall, Felipe C Albuquerque, Nancy K Hills, Robert C Wallace, Peter Nakaji
OBJECTIVE The Barrow Ruptured Aneurysm Trial (BRAT) is a prospective, randomized trial in which treatment with clipping was compared to treatment with coil embolization. Patients were randomized to treatment on presentation with any nontraumatic subarachnoid hemorrhage (SAH). Because all other randomized trials comparing these 2 types of treatments have been limited to saccular aneurysms, the authors analyzed the current BRAT data for this subgroup of lesions. METHODS The primary BRAT analysis included all sources of SAH: nonaneurysmal lesions; saccular, blister, fusiform, and dissecting aneurysms; and SAHs from an aneurysm associated with either an arteriovenous malformation or a fistula...
February 24, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28298024/reduction-of-inflammation-after-administration-of-interleukin-1-receptor-antagonist-following-aneurysmal-subarachnoid-hemorrhage-results-of-the-subcutaneous-interleukin-1ra-in-sah-scil-sah-study
#2
James Galea, Kayode Ogungbenro, Sharon Hulme, Hiren Patel, Sylvia Scarth, Margaret Hoadley, Karen Illingworth, Catherine J McMahon, Nikolaos Tzerakis, Andrew T King, Andy Vail, Stephen J Hopkins, Nancy Rothwell, Pippa Tyrrell
OBJECTIVE Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating cerebrovascular event with long-term morbidity and mortality. Patients who survive the initial bleeding are likely to suffer further early brain injury arising from a plethora of pathological processes. These may result in a worsening of outcome or death in approximately 25% of patients and may contribute to longer-term cognitive dysfunction in survivors. Inflammation, mediated by the cytokine interleukin-1 (IL-1), is an important contributor to cerebral ischemia after diverse forms of brain injury, including aSAH...
February 24, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28293714/dose-related-effect-of-statins-in-patients-with-endovascular-coiling-or-microsurgical-clipping-for-aneurysmal-subarachnoid-hemorrhage-updated-study-level-meta-analysis
#3
Kyu-Sun Choi, Jae Min Kim, Hyeong-Joong Yi, Seon-Heui Lee, Taeho Lim, Wonhee Kim, Youngsuk Cho, Jin-Hwan Cheong
PURPOSE: We aimed to quantitatively assess the effects of short-term statin use on delayed ischemic neurologic deficits (DINDs) and clinical outcomes in patients with aneurysmal subarachnoid hemorrhage (SAH) through a meta-analysis of the available evidence. METHODS: We searched the electronic databases up to April 8, 2016 to retrieve relevant studies comparing the outcomes between immediate statin-treated in statin-naïve patients and untreated patients following aneurysmal SAH...
March 14, 2017: European Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/28261039/first-description-of-reduced-pyruvate-dehydrogenase-enzyme-activity-following-subarachnoid-hemorrhage-sah
#4
Nadine Lilla, Hannah Füllgraf, Christian Stetter, Stefan Köhler, Ralf-Ingo Ernestus, Thomas Westermaier
Object: Several previous studies reported metabolic derangements and an accumulation of metabolic products in the early phase of experimental subarachnoid hemorrhage (SAH), which may contribute to secondary brain damage. This may be a result of deranged oxygen utilization due to enzymatic dysfunction in aerobic glucose metabolism. This study was performed to investigate, if pyruvate dehydrogenase enzyme (PDH) is affected in its activity giving further hints for a derangement of oxidative metabolism. Methods: Eighteen male Sprague-Dawley rats were randomly assigned to one of two experimental groups (n = 9): (1) SAH induced by the endovascular filament model and (2) sham-operated controls...
2017: Frontiers in Neuroscience
https://www.readbyqxmd.com/read/28250634/sudden-death-and-cervical-spine-a-new-contribution-to-pathogenesis-for-sudden-death-in-critical-care-unit-from-subarachnoid-hemorrhage-first-report-an-experimental-study
#5
Hizir Kazdal, Ayhan Kanat, Mehmet Dumlu Aydin, Ugur Yazar, Ali Riza Guvercin, Muhammet Calik, Betul Gundogdu
CONTEXT: Sudden death from subarachnoid hemorrhage (SAH) is not uncommon. AIMS: The goal of this study is to elucidate the effect of the cervical spinal roots and the related dorsal root ganglions (DRGs) on cardiorespiratory arrest following SAH. SETTINGS AND DESIGN: This was an experimental study conducted on rabbits. MATERIALS AND METHODS: This study was conducted on 22 rabbits which were randomly divided into three groups: control (n = 5), physiologic serum saline (SS; n = 6), SAH groups (n = 11)...
January 2017: Journal of Craniovertebral Junction and Spine
https://www.readbyqxmd.com/read/28244007/effects-of-tenascin-c-knockout-on-cerebral-vasospasm-after-experimental-subarachnoid-hemorrhage-in-mice
#6
Masashi Fujimoto, Masato Shiba, Fumihiro Kawakita, Lei Liu, Naoshi Shimojo, Kyoko Imanaka-Yoshida, Toshimichi Yoshida, Hidenori Suzuki
A matricellular protein tenascin-C (TNC) has been suggested to play a role in the pathogenesis of cerebral vasospasm after subarachnoid hemorrhage (SAH), but the direct evidence remains lacking. In this study, we examined effects of TNC knockout (TNKO) on cerebral vasospasm after experimental SAH in mice. C57BL/6 wild-type (WT) or TNKO mice were subjected to SAH by endovascular puncture. Ten WT and ten TNKO mice were randomized to WT sham (n = 4), TNKO sham (n = 4), WT SAH (n = 6), and TNKO SAH (n = 6) groups...
February 27, 2017: Molecular Neurobiology
https://www.readbyqxmd.com/read/28242775/role-of-periostin-in-early-brain-injury-after-subarachnoid-hemorrhage-in-mice
#7
Lei Liu, Fumihiro Kawakita, Masashi Fujimoto, Fumi Nakano, Kyoko Imanaka-Yoshida, Toshimichi Yoshida, Hidenori Suzuki
BACKGROUND AND PURPOSE: A matricellular protein tenascin-C is implicated in early brain injury after experimental subarachnoid hemorrhage (SAH). This study first evaluated the role of another matricellular protein periostin and the relationships with tenascin-C in post-SAH early brain injury. METHODS: Wild-type (n=226) and tenascin-C knockout (n=9) C57BL/6 male adult mice underwent sham or filament perforation SAH modeling. Vehicle, anti-periostin antibody, or recombinant periostin was randomly administrated by an intracerebroventricular injection at 30 minutes post-modeling...
February 27, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28236213/ethyl-pyruvate-attenuates-early-brain-injury-following-subarachnoid-hemorrhage-in-the-endovascular-perforation-rabbit-model-possibly-via-anti-inflammation-and-inhibition-of-jnk-signaling-pathway
#8
Tao Lv, Yi-Feng Miao, Yi-Chao Jin, Shao-Feng Yang, Hui Wu, Jiong Dai, Xiao-Hua Zhang
Early brain injury (EBI) following subarachnoid hemorrhage (SAH) is the main cause to poor outcomes of SAH patients, and early inflammation plays an important role in the acute pathophysiological events. It has been demonstrated that ethyl pyruvate (EP) has anti-inflammatory and neuroprotective effects in various critical diseases, however, the role of EP on EBI following SAH remains to be elucidated. Our study aimed to evaluate the effects of EP on EBI following SAH in the endovascular perforation rabbit model...
February 25, 2017: Neurochemical Research
https://www.readbyqxmd.com/read/28210956/mdivi-1-alleviates-early-brain-injury-after-experimental-subarachnoid-hemorrhage-in-rats-possibly-via-inhibition-of-drp1-activated-mitochondrial-fission-and-oxidative-stress
#9
Pei Wu, Yuchen Li, Shiyi Zhu, Chunlei Wang, Jiaxing Dai, Guang Zhang, Bingjie Zheng, Shancai Xu, Ligang Wang, Tongyu Zhang, PeiQuan Zhou, John H Zhang, Huaizhang Shi
Mdivi-1 is a selective inhibitor of mitochondrial fission protein, Drp1, and can penetrate the blood-brain barrier. Previous studies have shown that Mdivi-1 improves neurological outcomes after ischemia, seizures and trauma but it remains unclear whether Mdivi-1 can attenuate early brain injury after subarachnoid hemorrhage (SAH). We thus investigated the therapeutic effect of Mdivi-1 on early brain injury following SAH. Rats were randomly divided into four groups: sham; SAH; SAH + vehicle; and SAH + Mdivi-1...
February 16, 2017: Neurochemical Research
https://www.readbyqxmd.com/read/28169856/postinterventional-critical-care-management-of-aneurysmal-subarachnoid-hemorrhage
#10
Sudhir Datar, Alejandro A Rabinstein
PURPOSE OF REVIEW: Subarachnoid hemorrhage from a ruptured aneurysm (aSAH) is a complex disorder with the potential to have devastating effects on the brain as well as other organ systems. After more than 3 decades of research, the underlying pathophysiologic mechanisms remain incompletely understood and important questions remain regarding the evaluation and management of these patients. The purpose of this review is to analyze the recent literature and improve our understanding of certain key clinical aspects...
April 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28059660/effects-of-decompressive-craniectomy-on-functional-outcomes-and-death-in-poor-grade-aneurysmal-subarachnoid-hemorrhage-a-systematic-review-and-meta-analysis
#11
Naif M Alotaibi, Ghassan Awad Elkarim, Nardin Samuel, Oliver G S Ayling, Daipayan Guha, Aria Fallah, Abdulrahman Aldakkan, Blessing N R Jaja, Airton Leonardo de Oliveira Manoel, George M Ibrahim, R Loch Macdonald
OBJECTIVE Patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH) (World Federation of Neurosurgical Societies Grade IV or V) are often considered for decompressive craniectomy (DC) as a rescue therapy for refractory intracranial hypertension. The authors performed a systematic review and meta-analysis to assess the impact of DC on functional outcome and death in patients after poor-grade aSAH. METHODS A systematic review and meta-analysis were performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines...
January 6, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28033279/the-effect-of-fenestration-of-the-lamina-terminalis-on-the-incidence-of-shunt-dependent-hydrocephalus-after-aneurysmal-subarachnoid-hemorrhage-fish-study-protocol-for-a-randomized-controlled-trial
#12
RANDOMIZED CONTROLLED TRIAL
Chuanyuan Tao, Chaofeng Fan, Xin Hu, Junpeng Ma, Lu Ma, Hao Li, Yi Liu, Hong Sun, Min He, Chao You
BACKGROUND: Shunt-dependent hydrocephalus (SDH) is a well-known sequela following aneurysmal hemorrhage, adversely affecting the outcome after securing ruptured aneurysm. Fenestration of lamina terminalis (FLT) creates an anterior ventriculostomy, facilitates cerebrospinal fluid circulation and clot clearance in the basal cistern. However, controversy exists over whether microsurgical FLT during aneurysm repair can decrease the incidence of SDH. AIMS: The study is designed to determine the efficacy of lamina terminalis fenestration on the reduction of SDH after aneurysm clipping...
December 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28028144/valproate-reduces-delayed-brain-injury-in-a-rat-model-of-subarachnoid-hemorrhage
#13
Arend M Hamming, Annette van der Toorn, Umesh S Rudrapatna, Lisha Ma, Hine J A van Os, Michel D Ferrari, Arn M J M van den Maagdenberg, Erik van Zwet, Katherine Poinsatte, Ann M Stowe, Rick M Dijkhuizen, Marieke J H Wermer
BACKGROUND AND PURPOSE: Spreading depolarizations (SDs) may contribute to delayed cerebral ischemia after subarachnoid hemorrhage (SAH). We tested whether SD-inhibitor valproate reduces brain injury in an SAH rat model with and without experimental SD induction. METHODS: Rats were randomized in a 2×2 design and pretreated with valproate (200 mg/kg) or vehicle for 4 weeks. SAH was induced by endovascular puncture of the right internal carotid bifurcation. One day post-SAH, brain tissue damage was measured with T2-weighted magnetic resonance imaging, followed by cortical application of 1 mol/L KCl (to induce SDs) or NaCl (no SDs)...
December 27, 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28010884/efficacy-of-lumbar-cistern-drainage-combined-with-intrathecal-antibiotherapy-for-the-treatment-of-ventriculo-subarachnoid-infections-following-surgery-for-hypertensive-intracerebral-hemorrhage
#14
Q-H Chen, D Lin, Q-G Yu, J Zhou
OBJECTIVE: The aim of this study was to investigate the efficacy of lumbar cistern drainage combined with intrathecal injection of antibiotics (LCD-ITI) in treating postoperative intracranial infections of hypertensive intracerebral hemorrhage (pHIH-ICI). METHODS: Sixty pHIH-ICI patients were randomly divided into the control group and the treatment group, with 30 patients in each group. Conventional treatment was performed in the control group, while LCD-ITI was performed in the treatment group...
December 20, 2016: Neuro-Chirurgie
https://www.readbyqxmd.com/read/28004163/treatment-of-cerebral-vasospasm-following-aneurysmal-subarachnoid-haemorrhage-a-systematic-review-and-meta-analysis
#15
Grégoire Boulouis, Marc Antoine Labeyrie, Jean Raymond, Christine Rodriguez-Régent, Anne Claire Lukaszewicz, Damien Bresson, Wagih Ben Hassen, Denis Trystram, Jean Francois Meder, Catherine Oppenheim, Olivier Naggara
OBJECTIVES: To examine the clinical outcome of aneurysmal subarachnoid haemorrhage (aSAH) patients exposed to cerebral vasospasm (CVS)-targeted treatments in a meta-analysis and to evaluate the efficacy of intra-arterial (IA) approaches in patients with severe/refractory vasospasm. METHODS: Randomised controlled trials, prospective and retrospective observational studies reporting clinical outcomes of aSAH patients exposed to CVS targeted treatments, published between 2006-2016 were searched using PubMed, EMBASE and the Cochrane Library...
December 21, 2016: European Radiology
https://www.readbyqxmd.com/read/28000129/management-of-external-ventricular-drains-after-subarachnoid-hemorrhage-a-multi-institutional-survey
#16
David Y Chung, Thabele M Leslie-Mazwi, Aman B Patel, Guy A Rordorf
BACKGROUND: Patients with aneurysmal subarachnoid hemorrhage (SAH) often develop hydrocephalus requiring an external ventricular drain (EVD). The best available evidence suggests that a rapid EVD wean and intermittent CSF drainage is safe, reduces complications, and shortens ICU and hospital length of stay as compared to a gradual wean and continuous drainage. However, optimal EVD management remains controversial and the baseline practice among neurological ICUs is unclear. Therefore, we sought to determine current institutional practices of EVD management for patients with aneurysmal SAH...
December 20, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27933551/pentoxifylline-alleviates-early-brain-injury-after-experimental-subarachnoid-hemorrhage-in-rats-possibly-via-inhibiting-tlr-4-nf-%C3%AE%C2%BAb-signaling-pathway
#17
Da-Yong Xia, Hua-Sheng Zhang, Ling-Yun Wu, Xiang-Sheng Zhang, Meng-Liang Zhou, Chun-Hua Hang
Early brain injury (EBI) after subarachnoid hemorrhage (SAH) generally causes significant and lasting damage. Pentoxifylline (PTX), a nonselective phosphodiesterase inhibitor, has shown anti-inflammatory and neuroprotective properties in several brain injury models, but the role of PTX with respect to EBI following SAH remains uncertain. The purpose of this study was to investigate the effects of PTX on EBI after SAH in rats. Adult male Sprauge-Dawley rats were randomly assigned to the sham and SAH groups. PTX (30 or 60 mg/kg) or an equal volume of the administration vehicle (normal saline) was administrated at 30 min intervals following SAH...
December 8, 2016: Neurochemical Research
https://www.readbyqxmd.com/read/27932607/randomized-open-label-phase-1-2a-study-to-determine-the-maximum-tolerated-dose-of-intraventricular-sustained-release-nimodipine-for-subarachnoid-hemorrhage-newton-nimodipine-microparticles-to-enhance-recovery-while-reducing-toxicity-after-subarachnoid-hemorrhage
#18
Daniel Hänggi, Nima Etminan, Francois Aldrich, Hans Jakob Steiger, Stephan A Mayer, Michael N Diringer, Brian L Hoh, J Mocco, Herbert J Faleck, R Loch Macdonald
BACKGROUND AND PURPOSE: We conducted a randomized, open-label, phase 1/2a, dose-escalation study of intraventricular sustained-release nimodipine (EG-1962) to determine safety, tolerability, pharmacokinetics, and clinical effects in aneurysmal subarachnoid hemorrhage. METHODS: Subjects with aneurysmal subarachnoid hemorrhage repaired by clipping or coiling were randomized to EG-1962 or enteral nimodipine. Subjects were World Federation of Neurological Surgeons grade 2 to 4 and had an external ventricular drain...
January 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27927658/aneurysmal-subarachnoid-hemorrhage-red-blood-cell-transfusion-and-outcome-sahara-a-pilot-randomised-controlled-trial-protocol
#19
Shane W English, D Fergusson, M Chassé, A F Turgeon, F Lauzier, D Griesdale, A Algird, A Kramer, A Tinmouth, C Lum, J Sinclair, S Marshall, D Dowlatshahi, A Boutin, G Pagliarello, L A McIntyre
INTRODUCTION: Anaemia is common in aneurysmal subarachnoid haemorrhage (aSAH) and is a potential critical modifiable factor affecting secondary injury. Despite physiological evidence and management guidelines that support maintaining a higher haemoglobin level in patients with aSAH, current practice is one of a more restrictive approach to transfusion. The goal of this multicentre pilot trial is to determine the feasibility of successfully conducting a red blood cell (RBC) transfusion trial in adult patients with acute aSAH and anaemia (Hb ≤100 g/L), comparing a liberal transfusion strategy (Hb ≤100 g/L) with a restrictive strategy (Hb ≤80 g/L) on the combined rate of death and severe disability at 12 months...
December 7, 2016: BMJ Open
https://www.readbyqxmd.com/read/27907969/neuroprotection-in-critical-care-neurology
#20
Menno R Germans, Hieronymus D Boogaarts, R Loch Macdonald
Ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and traumatic brain injury-all have in common early brain injury due to brain tissue destruction, reduced cerebral blood flow and oxygen delivery, and overall substantial morbidity and mortality. The pathophysiology of brain tissue damage likely includes common cellular mechanisms. Neuroprotection has seldom, if ever, been shown to reduce early brain injury. Secondary brain injury develops after these conditions due to macroscopic events such as increased intracranial pressure and reduced cerebral blood flow, as well as cellular processes including vascular damage, inflammation, and apoptotic/necrotic cell death...
December 2016: Seminars in Neurology
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